Print form and mail or
fax to: 941-484-1410
CONFERENCE REGISTRATION FORM
20th Annual National
Health Benefits Conference & Expo (HBCE)
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January 31 - February 1, 2011
Sheraton Sand Key Resort, Clearwater Beach, FL
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REGISTRATION FEES - SAVE YOUR SPACE - BEST CONFERENCE VALUE FOR 2011
Employer Gov't./Educ./Non-Profit Commercial ( * footnote)
by 10/31 by 12/31 >1/20 by 10/31 by 12/31 >1/20 by 10/31 by 12/31 >1/20
1st Person $275 $295 $345 $250 $275 $325 $325* $345* $395*
Second 250 275 325 225 250 295 295 325 375
Third 225 250 295 195 225 275 275 295 345
Fourth FREE ------------------ > FREE -------------------- > FREE ------------------ >
Optional Workshop
(w/ lunch)** 65 75 85 50 60 70 75* 85* 95*
* Commercial: Supplier of health services or related products/services to employers, including consultants.
** Workshops A, B and C: To be Announced
No penalty if cancel by 1/15/11; $50 after that date. Substitutions allowed by calling HBCE (941-484-1430) ahead of time.
Name & Title:______________________________________________________________________________
Name & Title (2nd):__________________________________________________________________________
Company/Employer:_________________________________________________________________________
Street:____________________________________________________________________________________
City:________________________________________State:__________Zip:____________________________
Phone:_____________________________________________Fax:___________________________________
E-mail(s):_________________________________________________________________________________
Please make CHECKS payable to:
Health Benefits Conference & Expo
Send to:
500 The Esplanade, Suite 205
Venice, FL 34285-1533
Phone: 941-484-1430
Fax: 941- 484-1410 (many complete
this form and FAX with payment
by credit card or send check later)
E-mail: info (at) HBCE.com
_____ Please invoice/bill my employer.
Or pay by CREDIT CARD & mail or FAX to: 941- 484-1410
Credit Card (circle or check) MC___ VISA___ AMEX___
Card No.__________________________________
CVV #: 3 #s on back, except AMEX (4 #s on front)_______
Exp. Date______________Total $______________
Signature _________________________________
Name on Card______________________________
TIN: 20-1571141
TAX DEDUCTIBILITY: Expenses of training, including registration, lodging & meals, incurred to maintain
or improve skills in your profession, may be tax deductible. Consult your tax advisor.
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